A Word from Dr. Pfenninger: Immunizations and what we have forgotten

Dr. John L. Pfenninger for the Daily News

Updated 5:00 am, Tuesday, April 14, 2015

“We have had measles in the house, and I write under great affliction. Thomas was seized a few days ago, i.e., last Thursday. He was held most favorable til eleven this morning, when a sudden change took place; and, with sorrow of heart, I write, he died. Sweet, innocent, about six this afternoon. His sufferings were short, and I think not severe. Pray, come as soon as you can. My sister is not at home. Mrs. Wordsworth bears her loss with striking fortitude, and Miss Hutchinson is as well as can be expected. My sister will come here tomorrow.” William Wordsworth, December 1, 1812, regarding the death of his six-year old son.

“In 1736, I lost one of my sons, a fine boy of four-years old, by the smallpox, taken in the common way. I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.” From the autobiography of Benjamin Franklin.

Last fall, in the same week, two patient histories that involved immunizations struck me. The first was a 60-some-year old man who used crutches to enter the exam room. Out of curiosity I asked why he needed the crutches. He responded that both he and his father contracted polio just months before the polio vaccine became available. His father died, and he was crippled for life. In another encounter, the family history noted that an infant son had died. I asked what caused his death. “Meningitis. It’s too bad we didn’t have the immunization back then.”

Sometimes stories are the best way to communicate about various issues. I encounter questions about the benefits of vaccines on a regular basis as a physician. Most people, however, forget what it used to be like without them. I was just finishing medical school when the University of Michigan was removing the last of the “iron lungs” that they used to support polio victims. I am old enough to still remember the stories of my “elders.”

Stories, however, are not science. So many stories are the results of coincidence. As the stories become embellished, they wander from fact. And so, there is now a movement against immunizations. As immunization rates fall, we see the return of measles in Disneyland and pertussis (whooping cough) right here at MidMichigan Medical Center and in the schools. More communicable diseases are likely to return. Some 37,000 people died during 2013-14 in the U.S. from the flu. Nearly all were not immunized.

The only intervention in human history that has had more health effects and saved more lives than vaccination has been the availability of clean water. Yet, many parents and individuals will decline receiving vaccines or choosing them for their children. In the past, some simply could not afford vaccines for numerous children. Now, under the Affordable Care Act, immunizations must be covered by insurance with no co-pay or deductible for the patient.

I received a referral this week from a pediatrician. The child was 5 years old. The electronic medical record documented that all immunizations were “permanently declined.” A mother came into my office with her teenaged daughter last week. I asked if she had received the human papillomavirus vaccine (HPV vaccine). The mother replied no. I asked why she wouldn’t want to prevent cervical, vaginal, vulvar, anal and throat cancer in her daughter. She had an interesting response: “I’m not stupid. What harmful effects are they going to find from this in a few years?” I responded, “It’s been out for nearly 15 years in Europe and is totally safe.” She still said no.

The California legislature has a controversial bill proposed to abolish all vaccine exemptions in the Golden State, except for medical reasons. Many times, parents claimed waivers out of convenience. A new state law, which went into effect here in Michigan on Jan. 1, now requires parents who wish to submit vaccine waivers to attend an educational session at their local health department before a valid waiver is released. I think that this law will encourage more parents to have their children immunized, but I still think there is a core group that fundamentally believes immunizations are harmful.

One has to look at science for an answer. I agree, sometimes even the “hard science” can be confusing. One year scientists say one thing and then the next year, another. However, the science on immunizations has been consistent. There has been some “junk science” in the past which claimed immunizations caused autism. This truly put a fear in everyone. Now, 14 quality studies confirm that there is no risk of autism with immunizations. And yet, parents remain skeptical. The difficulty for many is, whom do you trust? How do you sort out the quality science from the “junk”?

The information itself can also be confusing. The U.S. government runs a fund to compensate parents whose children have been harmed via immunizations. Some people use this fact to prove that immunizations cause problems: “After all, the government wouldn’t pay up if there was no harm done.” However, there is more to the story. With liability like it is here in the U.S., any coincidental occurrence can be a potential lawsuit. Consequently, anytime a child received an immunization of any sort, and then suffered some type of medical condition, parents and lawyers were quick to sue. Companies making vaccines faced increasing litigation, exorbitant legal fees and large jury rewards based on sympathy. Pharmaceutical companies ceased making vaccines. By the end of 1984, only one U.S. company still manufactured the DPT vaccine. After the National Childhood Vaccine Injury Act was passed that compensated individuals potentially harmed by vaccines, manufacturers resurfaced. Now, there are six U.S. manufacturers that supply most of the vaccines. The law was passed not because the vaccines cause harm, but rather to allow companies to function in the adverse legal climate that we have.

Beliefs, no matter how heartfelt, are not a sensible substitute for an objective evaluation of the risks and benefits of immunizations. Immunizations were introduced in the 18th century to overcome smallpox. There are now immunizations of all sorts to prevent numerous communicable diseases.

For those who want to learn more, there will be a free informational session on vaccines from 6 p.m. to 7:30 p.m. on Tuesday in Towsley Auditorium at MidMichigan Medical Center-Midland. The session is open to the public and is sponsored by the Midland County Medical Society Alliance, MidMichigan Medical Center-Midland, Midland County Health Department and the Michigan State Medical Society Foundation. Three presenters will discuss the current outbreak of whooping cough (pertussis) and measles, and provide a current and factual review of the rapidly changing field of immunizations. Dinner will be provided. For more information go to www.midmichigan.org/immunize or contact Linda Allen at (989) 835-9809.

Dr. John L. Pfenninger’s office, Medical Procedures Center, is located in Midland.